Marvellous – the farce that was orientation is over…
Our last couple of days proved to us even more that there is a great deal of work to do, not only with the students, but something has to be done about the staff nurses! I watched in complete disbelief as a fairly newly qualified nurse did a drugs round – incompetence isn’t the word – dangerous more like! And before all you non-nursey people start thinking about defending her because she’s new – don’t! She should have known better and if any nurse mentor in the UK had even thought about signing this girl off as a competent practitioner, they should have been stuck off!!
We were on the Paeds ward and thankfully it was no where near full, I don’t know what would have happened had there been more than the 10 or so children that were there. After spending the morning tagging along on the ward round (during which I nearly slipped into another boredom induced coma) we hung about for a while quizzing this nurse on a few things – well, good job we weren’t on an official fact finding mission. She didn’t know a great deal and certainly nothing about interpreting the blood forms or results slips, her approach to infection control was unusual to say the least but her crowning glory was the performance at the drugs trolley!
She collected up the drugs charts and opened up the trolley, not that was locked or anything silly like that. She picked some pots off the tray and slotted them into a holder thingy, got some tape and wrote the bed numbers on it – it sounds alright so far, I know, but wait… She then read off the first drug, Cloxacillin, which comes in capsules of 500mg. The dose was for 250mg, so she fished one capsule out of the pot (labelled Prednisolone by the way, but Cloxa written on the lid). She breaks it open, scoops half out, tips it into the little pot and fixes the capsule back together and drops it back into the pot with all the others. ‘Whoah, there’ I thought, ‘are you serious’! I took it straight back out again and holding it in my hand asked her how she’d know whether it was a full 500mg or something less than that next time round. I got a totally blank look in return and after a little while, a very quiet ‘Oh’. I fling the capsule in the bin, giving her the benefit of the doubt, and let her carry on. Next drug is paracetamol, again a 500mg tablet but we need 125mg this time. She picks it up, breaks it in half, returns one half to the pot and carries on trying to break the other half in two again. There was pill cutter sitting in the trolley, just by her, so I inquired if they ever used pill cutters, assuming she’d twig and stop fingering the tablet. ‘ No, we don’t have them’ ‘Oh, really, h’mmm’ I think! She finally succeeds in snapping a bit off and with a cursory check that its just the right amount, she drops it into a pestle and mortar for crushing. She bashes it about and finally tips it into the pot, with the Cloxa and drug dust from the bowl that has been there since the beginning of time. There is obviously no danger of drug resistance, anaphylaxsis etc etc out here!
We then come to acetominaphen... the prescription was for a 3 week old and said 62.5mg, syrup. After she'd finally managed to locate the right bottle, an extremely lengthy calculation session, written in biro on the palm of her hand ensued, with many crossings out, decimal points all over the place and a lot of furrowed brow activity. Ali gave in, 'so if there is 80mg in 0.8ml, that means 10mg in 0.1ml doesn't it Clare', 'Yes, Ali, I think you're right, so you think it should be 0.6mg to do you?' Nursey just doesn't get the hint and she continued scribbling away. 3 hours later....not really, but it felt like it, she takes the bottle and dips the eye dropper thing in, sucks up the syrup and trys to measure it out - the trouble is there is only 0.4ml and 0.8ml marked on the side - she squirts it in and out, in and out, gaining air bubbles like there was no tomorrow - Ali finally cracked, unwrapped a syringe, took the bottle and measured it out. Nursey was not a happy bunny and it may not have been the best move, but for the sake of our sanity it had to be done!
We perserved with the rest of the round, steadily losing faith in the nursing training , assessment procedures and anything else remotely to do with safe practice...but since it was the penultimate day we jsut thought, lets get through it and deal with this later.
Nursey's final parting shot was to ask Sister Ali her opinion on something the Clinical Officer had written in the notes of patient that for some bizarre reason was in traction – not for any orthopaedic reason we could see – but in order to keep his dressings in place, it said in the notes. Anyway, Nursey asks Ali if it is possible to be on best rest and exercise through ambulation at the same time? ‘ Ummmm, no, I don’t think so’ says Al, very diplomatically while I try and suppress my giggles!
We just couldn't have stood for anymore, luckily we got our papers signed and stamped by Matron and hot footed it up to Blantyre!
Our last couple of days proved to us even more that there is a great deal of work to do, not only with the students, but something has to be done about the staff nurses! I watched in complete disbelief as a fairly newly qualified nurse did a drugs round – incompetence isn’t the word – dangerous more like! And before all you non-nursey people start thinking about defending her because she’s new – don’t! She should have known better and if any nurse mentor in the UK had even thought about signing this girl off as a competent practitioner, they should have been stuck off!!
We were on the Paeds ward and thankfully it was no where near full, I don’t know what would have happened had there been more than the 10 or so children that were there. After spending the morning tagging along on the ward round (during which I nearly slipped into another boredom induced coma) we hung about for a while quizzing this nurse on a few things – well, good job we weren’t on an official fact finding mission. She didn’t know a great deal and certainly nothing about interpreting the blood forms or results slips, her approach to infection control was unusual to say the least but her crowning glory was the performance at the drugs trolley!
She collected up the drugs charts and opened up the trolley, not that was locked or anything silly like that. She picked some pots off the tray and slotted them into a holder thingy, got some tape and wrote the bed numbers on it – it sounds alright so far, I know, but wait… She then read off the first drug, Cloxacillin, which comes in capsules of 500mg. The dose was for 250mg, so she fished one capsule out of the pot (labelled Prednisolone by the way, but Cloxa written on the lid). She breaks it open, scoops half out, tips it into the little pot and fixes the capsule back together and drops it back into the pot with all the others. ‘Whoah, there’ I thought, ‘are you serious’! I took it straight back out again and holding it in my hand asked her how she’d know whether it was a full 500mg or something less than that next time round. I got a totally blank look in return and after a little while, a very quiet ‘Oh’. I fling the capsule in the bin, giving her the benefit of the doubt, and let her carry on. Next drug is paracetamol, again a 500mg tablet but we need 125mg this time. She picks it up, breaks it in half, returns one half to the pot and carries on trying to break the other half in two again. There was pill cutter sitting in the trolley, just by her, so I inquired if they ever used pill cutters, assuming she’d twig and stop fingering the tablet. ‘ No, we don’t have them’ ‘Oh, really, h’mmm’ I think! She finally succeeds in snapping a bit off and with a cursory check that its just the right amount, she drops it into a pestle and mortar for crushing. She bashes it about and finally tips it into the pot, with the Cloxa and drug dust from the bowl that has been there since the beginning of time. There is obviously no danger of drug resistance, anaphylaxsis etc etc out here!
We then come to acetominaphen... the prescription was for a 3 week old and said 62.5mg, syrup. After she'd finally managed to locate the right bottle, an extremely lengthy calculation session, written in biro on the palm of her hand ensued, with many crossings out, decimal points all over the place and a lot of furrowed brow activity. Ali gave in, 'so if there is 80mg in 0.8ml, that means 10mg in 0.1ml doesn't it Clare', 'Yes, Ali, I think you're right, so you think it should be 0.6mg to do you?' Nursey just doesn't get the hint and she continued scribbling away. 3 hours later....not really, but it felt like it, she takes the bottle and dips the eye dropper thing in, sucks up the syrup and trys to measure it out - the trouble is there is only 0.4ml and 0.8ml marked on the side - she squirts it in and out, in and out, gaining air bubbles like there was no tomorrow - Ali finally cracked, unwrapped a syringe, took the bottle and measured it out. Nursey was not a happy bunny and it may not have been the best move, but for the sake of our sanity it had to be done!
We perserved with the rest of the round, steadily losing faith in the nursing training , assessment procedures and anything else remotely to do with safe practice...but since it was the penultimate day we jsut thought, lets get through it and deal with this later.
Nursey's final parting shot was to ask Sister Ali her opinion on something the Clinical Officer had written in the notes of patient that for some bizarre reason was in traction – not for any orthopaedic reason we could see – but in order to keep his dressings in place, it said in the notes. Anyway, Nursey asks Ali if it is possible to be on best rest and exercise through ambulation at the same time? ‘ Ummmm, no, I don’t think so’ says Al, very diplomatically while I try and suppress my giggles!
We just couldn't have stood for anymore, luckily we got our papers signed and stamped by Matron and hot footed it up to Blantyre!
Here are some pictures of the wards...
This is the general Paediatric ward
The diarrhoea room!! Nice...
The ICU (of sorts!)
Here is the classroom we'll teach in (when we start teaching .....)
and...here is my office - its got a desk and chair and everything - v exciting!
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